Breastfeeding to Reduce Breast Cancer in Young Mothers

Institution: Public Health Institute
Investigator(s): Alison Chopel, M.P.H. - Danielle Soto, MA, PhD -
Award Cycle: 2015 (Cycle 21) Grant #: 21AB-1000 Award: $110,014
Award Type: CRC Pilot Award
Research Priorities
Community Impact of Breast Cancer>Sociocultural, Behavioral, and Psychological Issues: the human side

Initial Award Abstract (2015)

Introduction:  The burden of breast cancer mortality among low-income women, women of color, and younger women, is disproportionately high. Adolescent mothers are an important target population given that adolescent parenthood is disproportionately concentrated in low-income communities and communities of color. Breastfeeding is significantly protective against breast cancer, especially against aggressive types. While younger age at first birth is protective against other cancers, the risk pattern for the most aggressive breast cancers is the opposite: younger mothers are at significantly higher risk. Both research and Brighter Beginnings (BB) experience have identified gaps in breastfeeding promotion, as well as gaps between intentions to breastfeed and actual breastfeeding behavior.

Question(s) or hypotheses:  What are the structural and social barriers to and motivators of breastfeeding that young mothers encounter during their child’s first year?

We hypothesize that there are multiple, intersecting factors that influence breastfeeding in this population, in part due to the multiple and overlapping oppressions/marginalizations experienced by many of them.

General methodology: We will conduct at least nine in-depth interviews with providers who work with the target population, six dyadic interviews with adolescent parents and their decision-making partners, and at least three community mapping sessions with adolescent mothers. Community mapping is a participatory action research method that allows communities to identify, align, and leverage their resources to support social and economic change at a community level. We will facilitate community mapping with small groups of three to six teen parents at each of the three BB study sites, focusing attention on social and physical spaces that influence their infant feeding behaviors by using a facilitator guide that will be developed in conjunction with the steering committee. We will use rapid assessment analysis to engage a subcommittee of steering committee members in the analysis and interpretation of the qualitative data.

Aim 1: To identify and describe the structural and social factors that influence breastfeeding among low-income young mothers in Alameda and Contra Costa Counties.
Aim 2: To design an intervention based on findings from Aim 1 that will be piloted in a subsequent study.
Aim 3: To strengthen and sustain an equitable, productive partnership between CAHC, BB, and the communities they represent.

Innovative elements: This is the only study that we know of addressing increased breastfeeding as a protective factor against breast cancer disparities, especially among adolescent mothers. This study will be the first that we are aware of to use community-based participatory research (CBPR) to engage young mothers and their providers as co-researchers to investigate and then act to improve breastfeeding rates. Findings from this study will contribute to increased knowledge of barriers to and facilitators of breastfeeding.

Community involvement: A Steering Committee (SC) comprised of representatives of BB, CAHC, local breast cancer advocates, lactation consultants (see letters of support from committed members), and BB client population (adolescent mothers) will guide all aspects of the proposed research. We expect to recruit at least three young mothers (one from each of our target areas) to join the SC as equal members. The role of the SC is to review all proposed research activities throughout the phases of the study (see timeline in proposal), provide input into the design of research tools and interpretation of results, to vet these tools and research findings with the groups they represent, and facilitate community feedback. They will also advise on when and how to engage the various community partners. Another key function of the SC will be to identify and help design a promising pilot intervention.

Future Plans: The proposed study will be the first step in our partnership’s long-term research agenda. This 18-month exploratory study to discover barriers to and facilitators of breastfeeding, enabling identification of one (or more) factor that is impactful and amenable to change, will prepare us to design, pilot and then evaluate an intervention. The next step will be a second 18-month project, in which we will collaboratively develop and pilot the community-driven policy or programmatic intervention in our focus population. These two studies will provide the foundation for a rigorous, three-year participatory intervention evaluation to measure its impact on breastfeeding initiation, duration and exclusivity. We believe that this three-step endeavor will yield significant contributions to understanding how breastfeeding behavior modification can enable breast cancer risk reduction in this vulnerable population.

Progress Report 1 (2016)

Breastfeeding is a modifiable behavior that can reduce breast cancer risk. In the US, adolescent mothers are more likely to belong to lower-income and racial/ethnic populations that have a higher risk for aggressive breast cancer types and other negative physical/mental health outcomes. They also have lower rates of breastfeeding than any other group of new mothers. Scientific and lay researchers are collaborating with young mothers trained as researchers to investigate the structural and social barriers to and motivators of breastfeeding that young mothers in California's Alameda and Contra Costa counties encounter during their child's first year.

We are pursuing this research goal through three specific aims:

Aim 1: To identify and describe the structural and social factors that influence breastfeeding among low-income young mothers in Alameda and Contra Costa Counties.

Aim 2: To design an intervention based on findings from Aim 1 that will be piloted in a subsequent study.

Aim 3: To strengthen and sustain an equitable, productive partnership between the California Adolescent Health Collaborative (CAHC), Brighter Beginnings (BB), and the communities they represent.

Our team is in the process of pursuing the first aim through three types of data collection. We have completed the first round of data collection and analysis, eight Key Informant Interviews. In the next phase of the study, we will collect more data through dyadic interviews and community mapping groups. We expect progress toward accomplishment of the second aim to follow once findings from all three types of data have been collected and analyzed. The third aim has been accomplished during the course of designing and conducting this study, and is also a continuous work in progress.

The biggest challenge we experienced in the first year was the turnover in young-mother researchers, which delayed the beginning of data collection. This is an understandable delay, given the considerable commitment that a project like this requires. One major positive change to the project was the addition of Bre’Jaynae Joiner as both lead young mother researcher and Co-Investigator (Co-I). Ms. Joiner contributes valuable insight to the team. Her performance in the first year of the grant led to the Co-Pis recruiting her to serve as a Co-I on the Breastfeeding to Reduce Breast Cancer in Young Mothers project. Dr. Danielle Soto has reduced her time on the project, and Bre’jaynae Joiner has joined the study’s leadership team as a Co-I and increased her dedicated time accordingly. In this role, she conducts research tasks including data collection and data analysis. Drs. Chopel and Soto mentor her as a Co-I. The team plans to bring her on as the Community Co-PI in future studies. This has enabled Dr. Soto to concentrate her time on the project towards planning, decision-making, and mentoring Ms. Joiner as a young researcher, thereby building capacity for a young mother to lead future research projects in the true spirit of CBPR.

The major accomplishments of the research project to date include: three young mothers trained with some research and leadership skills and breast cancer and breastfeeding knowledge, two retained as Co-Researchers; a thriving Advisory Council comprised of volunteers who represent multiple sectors and collaborate in research decisions; eight Key Informant Interviews collaboratively conducted and analyzed; and an abstract submitted for a conference presentation as well as a community presentation of findings planned for October.

We are about to embark upon the dyadic interviews and then shortly after that we will complete community mapping to enrich the findings we have from the Key Informant Interviews. Then, we will facilitate a collaborative process with the Advisory Council to interpret those findings and design a community-driven policy or programmatic intervention with the objective of increasing breastfeeding among young mothers ages 14 to 24 years in the East Bay. This funding has allowed us to design and implement this study in a novel way, as a Community-Based Participatory Research study, outcomes include not only increased generalizable knowledge but also improved skill and knowledge for people who are part of the participant population (young mothers) and those who serve them. As we begin to develop an intervention proposal, we will draw upon the strong partnership and increased capacity of our unique team.